LGBT+

About becoming LGBTQ friendly doctor

This semester we have new course, which main goal is to teach med students how to gather medical history from different types of patients in respectful and efficient way. Standardized patients (SPs) help us a lot. SPs are people who play the role of patients with whom students interact. This session was about gathering sexual history and assessing emotional and mental status of a patient.

The first patient is 40 year old man who comes to PCP (primary care physician) for starting hormonal therapy. His name is Michael, but the patient told that he prefers name Jenny and asked to refer as she/her (so, from now I’m going to use these pronouns). Jenny states that she has always felt differently, preferring doing “girly things” in childhood, but parents told her to “man up”. Jenny told that she recently has been divorced, and the marriage was overall unhappy; they have two teenage sons. She feels depressed and lonely, and in order to cope with the stress she drinks quite a lot. According to Jenny, she can drink up to one bottle of vodka per day. Mostly, she drinks alone. Jenny says that “it helps for a short period”. Moreover, according to the patient, she can’t fall asleep if she doesn’t drink. When doctor asked about her family, friends, she told that no one understands her. She has been in low mood for several months. She works in office and her co-workers know that she drinks a lot, and make comments behind her back: “Michael is drunkard, he smells awful”. This annoys her, but “I’ve got used to it”. When Jenny was asked about sexual health and practices she admitted that she had promiscuous sexual life, having numerous partners, both male and female; and she often didn’t use any protection. Then doctor asks whether Jenny sees another way to deal with the stress, as alcohol is clearly not the best option. She answers: “Well, I know that alcohol is bad for my health, but what else can I do?” Then, she mumbles: “I know that alcohol is going to kill me one day, or I’m going to do it myself”.

The second case was about 16 year old girl, Anya, who came to take a “sick note”, because she missed several classes in the past month. When doctor asks whether she has any complaints regarding her health, Anya answers: “No, I’m healthy, I just don’t want to go to school. It sucks. I hate people there”. Anya told the doctor, that her best friend spread Anya’s secret among classmates, and now they bully and mock her. Doctor assures the girl about confidentiality and asks to tell more about it. Anya admits that she had sex with a girl. She told her best friend about it. Anya states: “My friend reacted poorly, but I’d never expect that she’d tell everyone about it!” Anya haven’t been in school for one month. She stays at home, sleeping a lot, watching videos on her laptop. The girl says that it helps her to go away from reality. When doctor asked about her parents, the patient said: “They won’t understand. They only care about my grades. They think I’m just lazy, and that I don’t have any problems”. Also the doctor finds out that her aunt came out as lesbian, and now her family stopped any interaction with her and forbid their kids to talk with her. When the doctor suggests to talk to psychologist about this situation Anya agrees that it might help.

Needless to say, it was my favourite session).

Few things that every doctor should know when interacting with LGBTQ patient:

· Thank your patient for sharing info and trusting you.

· Don’t look judgmental and surprised.

· Assume nothing before asking a patient

· If you don’t know something, admit it. For example, in the first case patient wanted to discuss hormonal therapy, but doctor didn’t know much about it. Therefore, he suggested to make another appointment, so he would have time to learn more about the therapy.

· Assess the risk for depression and suicide. For example, Jenny clearly had Major Depression with suicidal thoughts. Doctor must be sure that she will be safe, in this case contacting social support worker will be good idea.

· Provide with psychological and social support if necessary. Anya is not depressed, but she nevertheless needs to meet a psychologist. Also, there are many support groups that help LGBTQ adolescents.

I hope that such courses will improve the quality of health care for LGBTQ patients.

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I one time told my therapist I had a sexual encounter with another girl. I then heard her and the nurse calling me a bunch of slurs. She called me these things in unofficial notes too. When i told her i would be changing therapists she got mad and o reported this behavior to my new one.

I was 13 and there cause of suicidal tendencies stemming from bullying.

Hello fellow med student! I'm not in med school or even college rn but I'm taking it when I get in college. And if I become a psychologist, I will remember this post. Thanks for sharing your experience! This was eye opening and remind me that I will meet LGBT+ patients and should remember their preferred pronouns.

Loved it! I am in nursing school and here were are struggling with the faculty board to introduce at least some sorte of LGBT+ related learning situation since most students don't even know what being trans means, for example. Hopefully it will work